A case report of a child with probable drug resistant tuberculous pericarditis with a review of challenges involved in diagnosis, treatment and follow up of children with DR-TB pericarditis
Journal
BMC Infectious DiseasesAbstract
Background: There are unique challenges in the diagnosis and management of multi drug resistant tuberculosis (MDR-TB) in children. It is difficult to obtain confirmatory microbiological diagnosis in TB pericarditis. It is essential to differentiate between drug sensitive and drug resistant forms of TB as it has a major bearing on the regimen used, and inappropriate TB treatment combined with steroid use for pericarditis can lead to deterioration. With lack of samples, the treatment decision relies on the drug resistance pattern of the close contact if available. Therapeutic challenges of MDR-TB management in a child involve use of toxic drugs that need to be judiciously handled. We report a 2 years 4 months old male child who was diagnosed with TB pericarditis and treated based on the resistance pattern of his mother who was on treatment for pulmonary MDR-TB. Case presentation: This 2 years 4 months old male child was diagnosed with TB involving his pericardium. Getting him started on an appropriate regimen was delayed due to the difficulty in establishing microbiological confirmation and drug susceptibility. He was commenced on a regimen based on his mother's drug resistance pattern and required surgery due to cardiac failure during the course of his treatment. He successfully completed 2 years of therapy. Conclusions: This child's case demonstrates that despite unique challenges in diagnosis and management of drug resistant extra pulmonary tuberculosis in children, treatment of even complex forms can be successful. The need for high suspicion of MDR-TB, especially when there is close contact with pulmonary TB, careful design of an effective regimen that is tolerated by the child, indications for invasive surgical management of pericarditis, appropriate follow-up and management of adverse effects are emphasised.Publisher
BMCPubMed ID
32321429Type
OtherArticle
Other
Language
enEISSN
1471-2334ae974a485f413a2113503eed53cd6c53
10.1186/s12879-020-05027-1
Scopus Count
Collections
Related articles
- [Pericarditis due to multidrug resistant Mycobacterium tuberculosis in an HIV infected patient: case report and review of literature].
- Authors: Lasso B M, Pérez G J
- Issue date: 2009 Apr
- Dilemma of managing asymptomatic children referred with 'culture-confirmed' drug-resistant tuberculosis.
- Authors: Loveday M, Sunkari B, Marais BJ, Master I, Brust JC
- Issue date: 2016 Jul
- Management of multidrug-resistant tuberculosis in children: a survival guide for paediatricians.
- Authors: Schaaf HS, Marais BJ
- Issue date: 2011 Mar
- Culture confirmed multidrug resistant tuberculosis: diagnostic delay, clinical features, and outcome.
- Authors: Schaaf HS, Shean K, Donald PR
- Issue date: 2003 Dec
- API TB Consensus Guidelines 2006: Management of pulmonary tuberculosis, extra-pulmonary tuberculosis and tuberculosis in special situations.
- Authors: API Consensus Expert Committee.
- Issue date: 2006 Mar